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OBJECTIVE: This study aimed to explore the experience of young men with traumatic brain injuries from regional, rural and remote areas in Australia who had participated in real life activity rehabilitation. DESIGN: A qualitative study. The primary data collection method was a semi-structured interview. SETTING: The Townsville Hospital, Queensland, and private dwellings in rural and regional areas within North Queensland. PARTICIPANTS: Eight male participants aged between 18-28 years. MAIN OUTCOME MEASURE(S): Key qualitative themes identified via thematic analysis of the data. RESULTS: This research identified 3 main themes regarding the patient's perspective of a real life activity intervention. These were: perceptions of the activities used in the intervention; insight into injury; and returning to previous activities of daily living. The findings of this study highlight incorporating real life activities assisted in engaging participants in rehabilitation. PARTICIPANTS expressed a desire for vocational activities to be included within rehabilitation activities. CONCLUSION: This study has clinical implications for real life activities to be incorporated as part of rehabilitation, and that this was preferred by young male traumatic brain injury patients. Therapists may consider using individualized real life activities with similar patient cohorts in the future.

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BACKGROUND: Lipoatrophic panniculitis (LP) is a rare disease of childhood characterized by eruption of tender erythematous nodules and plaques followed by circumferential bands of lipoatrophy often seen on the arms and legs. This condition has also been known as lipophagic panniculitis of childhood, annular atrophy of the ankles, and partial lipodystrophy. OBSERVATIONS: A previously healthy 8-year-old boy was evaluated for tender, raised plaques on the ankles, which progressed to circumferential atrophy of the distal lower extremities. Biopsy specimen analysis revealed a dense mixed infiltrate extending into the subcutaneous tissue as well as lipophages within the fatty lobules. A diagnosis of LP was made, and the patient began treatment with prednisone and hydroxychloroquine. Methotrexate was added later to the regimen as a steroid-sparing agent, and the dose was increased over the course of 3 months, by which time the cutaneous disease progression was nearly halted. However, the patient continued to have lower leg pain with bone changes demonstrated on magnetic resonance imaging. CONCLUSIONS: We report this case and review of the literature to call attention to the clinical features of LP and its association with skeletal changes. Our patient's response to combination therapy is of interest and contributes to the limited literature about management of this disease.

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OBJECTIVES: Human parvovirus B19 infection is associated not only with erythema infectiosum (fifth disease) but also, rarely, with purpuric or petechial rashes. Most reports of these atypical rashes describe sporadic cases with skin lesions that have distinctively focal distributions. During a community outbreak of fifth disease, we investigated a cluster of illnesses in children with generalized petechial rashes to determine whether parvovirus was the causative agent and, if so, to describe more fully the clinical spectrum of petechial rashes that are associated with this virus. METHODS: Systematic evaluation was conducted by general pediatricians of children with petechial rashes for evidence of acute parvovirus infection. RESULTS: During the outbreak, acute parvovirus infection was confirmed in 13 (76%) of 17 children who were evaluated for petechial rash. Confirmed case patients typically had mild constitutional symptoms, and most (11 [85%] of 13) had fever. Petechiae were typically dense and widely distributed; sometimes accentuated in the distal extremities, axillae, or groin; and usually absent from the head/neck. Most case patients had leukopenia, and several had thrombocytopenia. Parvovirus immunoglobulin M was detected in 8 (73%) of 11 acute-phase serum specimens, and immunoglobulin G was detectable only in convalescent specimens. Parvovirus DNA was detected in all 7 tested serum specimens, including 2 acute-phase specimens that were immunoglobulin M-negative. All case patients had brief, uncomplicated illnesses, but 6 were briefly hospitalized and 1 underwent a bone marrow examination. Two case patients developed erythema infectiosum during convalescence. CONCLUSIONS: During an outbreak of fifth disease, parvovirus proved to be a common cause of petechial rash in children, and this rash was typically more generalized than described in case reports. Associated clinical features, hematologic abnormalities, and serologic test results are consistent with a viremia-associated illness that is distinct from and occasionally followed by erythema infectiosum.

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